Healthcare Provider Details

I. General information

NPI: 1245565357
Provider Name (Legal Business Name): UNIVERSITY HEALTHCARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MIDDLEFIELD RD STE 260
MENLO PARK CA
94025-4010
US

IV. Provider business mailing address

321 MIDDLEFIELD RD
MENLO PARK CA
94025-3500
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-6500
  • Fax: 650-322-1321
Mailing address:
  • Phone: 650-498-6500
  • Fax: 650-322-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. KRISTINE RUSLEN
Title or Position: DIRECTOR
Credential:
Phone: 650-498-6631